1. Effects of Water, Sanitation, Handwashing, and Nutritional Interventions on Environmental Enteric Dysfunction in Young Children: A Cluster-randomized, Controlled Trial in Rural Bangladesh.
- Author
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Lin, Audrie, Ali, Shahjahan, Arnold, Benjamin F, Rahman, Md Ziaur, Alauddin, Mohammad, Grembi, Jessica, Mertens, Andrew N, Famida, Syeda L, Akther, Salma, Hossen, Md Saheen, Mutsuddi, Palash, Shoab, Abul K, Hussain, Zahir, Rahman, Mahbubur, Unicomb, Leanne, Ashraf, Sania, Naser, Abu Mohd, Parvez, Sarker M, Ercumen, Ayse, Benjamin-Chung, Jade, Haque, Rashidul, Ahmed, Tahmeed, Hossain, Md Iqbal, Choudhury, Nuzhat, Jannat, Kaniz, Alauddin, Sarah T, Minchala, Sandra G, Cekovic, Rabije, Hubbard, Alan E, Stewart, Christine P, Dewey, Kathryn G, Colford, John M, and Luby, Stephen P
- Subjects
Humans ,Water ,Sanitation ,Pregnancy ,Child ,Child ,Preschool ,Infant ,Rural Population ,Bangladesh ,Female ,Hand Disinfection ,early childhood intervention ,environmental enteric dysfunction ,environmental enteropathy ,nutrition ,water sanitation hygiene trial ,Clinical Trials and Supportive Activities ,Nutrition ,Clinical Research ,Digestive Diseases ,Prevention ,Pediatric ,Oral and gastrointestinal ,Clean Water and Sanitation ,Biological Sciences ,Medical and Health Sciences ,Microbiology - Abstract
BackgroundWe hypothesized that drinking water, sanitation, handwashing (WSH), and nutritional interventions would improve environmental enteric dysfunction (EED), a potential contributor to stunting.MethodsWithin a subsample of a cluster-randomized, controlled trial in rural Bangladesh, we enrolled pregnant women in 4 arms: control, WSH, child nutrition counseling plus lipid-based nutrient supplements (N), and nutrition plus WSH (N+WSH). Among the birth cohort, we measured biomarkers of gut inflammation (myeloperoxidase, neopterin), permeability (alpha-1-antitrypsin, lactulose, mannitol), and repair (regenerating gene 1β) at median ages 3, 14, and 28 months. Analysis was intention-to-treat.ResultsWe assessed 1512 children. At age 3 months, compared to controls, neopterin was reduced by nutrition (-0.21 log nmol/L; 95% confidence interval [CI], -.37, -.05) and N+WSH (-0.20 log nmol/L; 95% CI, -.34, -.06) interventions; similar reductions were observed at 14 months. At 3 months, all interventions reduced lactulose and mannitol (-0.60 to -0.69 log mmol/L). At 28 months, myeloperoxidase was elevated in the WSH and nutrition arms (0.23-0.27 log ng/mL) and lactulose was higher in the WSH arm (0.30 log mmol/L; 95% CI, .07, .53).ConclusionsReductions in permeability and inflammation at ages 3 and 14 months suggest that the interventions promoted healthy intestinal maturation; however, by 28 months, the WSH and nutrition arms showed elevated EED biomarkers. These results underscore the importance of developing a better understanding of EED pathophysiology and targeting interventions early in childhood, when they are likely to have the largest benefit to intestinal health.Clinical trials registrationNCT01590095.
- Published
- 2020